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Customer Service Health Care

Location:
India
Posted:
October 24, 2016

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Santhosh G

PROCESS ASSOICATE I AUDITOR

ABOUT ME

An experienced Claim process and trainer able to explain information clearly, recognize excellence in individuals, and inspire team members to achieve their potential while toward common goals

CONTACT

Door# 3, Sathiyamoorthy street, New Perungalathur, Chennai - 600063, TN

+91-997*******

acw7i6@r.postjobfree.com

Education

S.S.L.C From G.hr. Sec school, Perungattur

H.SC From G.hr. Sec school, Perungattur

B.E From Arunai Engg college, Tiruvannamalai

Adjudication

Adjudicate the Healthcare claims from leading third party insurance company in US

Accessing the members ‘and provider’s database

Validating the member’s history of eligibility in terms of name, age, dollar limit, lifetime maximum and other specific benefits with the respect

Validating the claims ‘provider/physician history and details

If any discrepancies are found in the claim, we will reject the claim and send them back to physician along with the rejection comment

Hobbies

Net Suffering

Reading news papers

Objective

I would like to obtain a position as a team-player in a people oriented organization where I can maximize my customer service experience in a challenging environment to achieve the corporate goal

Experiences

Company: SourceHOV

Role : Claim Processor

Year : 2013 to 2014

Place : Chennai

Company: Dell BPS

Role : Claim Sr Associate

Year : 2014 to 2015

Place : Chennai

Company: Accenture

Role : Claims Analyst and Claims Auditor

Year : 2015 to present

Tenure

Achievements

1st price in Chess Tournament held in my college

Received on the Spot Award 3 financial quarter

On 2014 I was awarded as Dell Business champion owing to handling the CBE transition successfully

Platform Experienced

OHI

Amisys

Facets

Work Culture

●Establishing and define the structure of learning content

●Facilitate the integration of content with the knowledge and experience of the trainees

●Having a call with onshore every week on clarifying the doubts

●Audit claim and track Error

●Feedback give processor relate to Error and Give training based on feedback to processor

●Conducting refresher sessions for the existing team members on every Friday and evaluate the team members, besides performance details would be shared to operation team.

●Being an Auditor I need to monitor the process documents on required basis and confirm with the onshore that we don’t have any ambiguities.

Language

English : Proficiency

Tamil : Expert

SKILLS

Communication

Problem solving

Team player

Data Management

Certification

CCNA

Dot Net

Clients

HPHC

United health care

BCBSNC



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